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Home , Quadrangular space, Triangular space

Dissections of the 10. Identify the cutaneous nerves in a prosected specimen Prepared by: Dr.J.K.Dissanayake 11. dissection review Senior Lecturer / Assisted by: Dr. Sidantha Ihagama Scapular region Temporary lecturer/ Anatomy 1. read the dissection overview This handout should be used with Grants Dissector 2. Review the skeleton of the scapular 14th edition region:page 22 Superficial veins and cutaneous nerves 3. In an articulated skeleton observe that the 1. Read the dissection overview medial angle of the scapula is applied to the 2. In the living observe the skin covering the second rib, while the inferior angle lies a. and . Move it on the against the seventh underlying structures. 4. In the dry bones Spot the skeletal elements b. there are numerous hairs and named to identify in the scapular region. many sudoriferous and sebaceous Page 22, fig.2.4 glands. 3. Using the bones/skeleton study and spot the c. medial side and front of the attachments of and compare with that on the lateral side and back of the arm 4. In the living and forearm a. Observe the upper end of the d. medial side and front of the humerus that produces the rounded forearm for the distribution of hair contour of the shoulder; it is and compare with that on lateral rounded and fuller in front than side and back of the arm and behind, where it presents a forearm e. region of the olecranon when somewhat flattened form. Above, extended and flexed . Move the b. Feel its anterior border which skin over the underlying structures forms the lateral boundary of the in both instances infraclavicular fossa. 2. What is the c. Feel along the lateral boundary a. superficial upto the insertion. b. deep fascia d. Feel along its posterior border 3. Draw a labelled diagram to illustrate the e. Observe the depression on the arrangement of superficial veins of the upper lateral side of the middle of the arm limb that marks its insertion. 4. Using a tourniquet occlude the superficial 5. Demonstrate the deltoid action in the living veins 6. Draw a diagram to illustrate the arrangement a. just above the cubital fossa of fibres of deltoid muscle b. about two finger breadths above the 7. Proceed with the dissection instructions in wrist observe the venous pattern page 22 5. Draw the dermatomes of the upper limb 8. Draw the 6. Follow the dissection guide skin incisions a. and its contents given in fig.2.2A(if you have already done it b. boundaries of the skip the skin incisions ) 9. Review dissections 7. Do not follow the skin incisions given in 10. Spot the fig.2.2B a. the boundaries of the triangular 8. Identify the superficial veins in the dissected space specimen and a procesected specimen b. , posterior 9. Spot the cephalic vein in the deltopectoral circumflex humeral artery/vein groove c. Teres minor d. Surgicall neck of the humerus 8. Proceed with the dissection instructions e. Quadrangular space, long head of page28. Do not cut the axillary vein at the brachii muscle lateral border of the teres major f. Teres major 9. Review dissections 11. Spot the attachment sites in bones of 10. Spot the following (refer the roster for relevant group a. Boundaries of the apex axilla task) b. Pectoralis major a. Teres minor c. Pectoralis minor b. Teres major d. Clavipectoral fascia c. Supraspinatus e. Latismus dorsi d. Infraspinatus f. Subscapularis e. Subscapularis g. Seratus anterior 12. Demonstrate the action of each muscle h. Intertubercular sulcus of humerus mentioned above. Tabulate their nerve 11. Abduct the arm and observe the lower five supply and spinal segments. or six serrations form a zigzag line with a 13. Spot suprascapular artery and nerve in the general convexity forward infraspinatus fossa just beneath the great 12. Spot the scapular notch /transverse scapular ligament a. Axillary vein 14. Draw a diagram to illustrate the scapular b. Cephalic vein opening in the anastamoses axillary vein 15. What are the parent arteries connected by c. Axillary artery the anastamoses?? d. Subclavian artery 16. Study the radiograph provided (chest PA – e. Superior thoracic artery scapula/clavicle/upper end of humerus) f. Thoraco acromial artery g. Lateral thoracic artery h. Acromial branch Axilla i. Deltoid branch 1. Read the overview j. Pectoral branch 2. In the living hold the anterior and posterior k. Clavicular branch axillary folds and Identify the muscles that l. Subscapular artery forms it m. Anterior circumflex humeral artery 3. Feel the apex of the axilla using the finger n. Circumflex scapular artery tips thoracodorsal artery 4. Feel the medial and lateral walls 13. Record variations of the branching pattern of 5. Identify the digitations of serratus anterior arteries in your cadaver observe variations in 6. Draw a labelled diagram/s to illustrate the other cadavers a. boundaries of the axilla and 14. Identify the roots of brachial plexus (spot) in contents the neck and follow them to trunks (spot) b. extent and the branches of the divisions(spot) and cords. Record variations. axillary artery 15. Spot the terminal branches /medial and c. contents of the lateral pectoral nerves/medial cutaneous d. formation of brachial plexus and nerve of arm and forearm/long thoracic its terminal branches nerve (prerequisite: recall limb 16. Draw a labelled diagram to illustrate the innervations ) a. branches of the posterior cord 7. Describe the formation of axillary sheath b. arrangement of lymph nodes in the axilla 14. In the living identify the coracobrachialis and . Arm and cubital fossa 15. Spot 1. Read the dissection overview a. Median nerve 2. Study the skeleton of arm and cubital b. Ulnar nerve region(recall) c. Brachial artery 3. In the living feel the acromioclavicular joint d. Ulnar artery while the arm is hanging by the side with the e. Radial artery palm of the forward. Bring uoyr finger 16. Study the surface projections of the brachial straight down in front to feel the artery. Mark it on the skin using a non toxic intertubercular groove (use deep palpation ) water soluble pen. 4. Spot 17. In the living feel behind and lateral to the a. Supraglenoid tubercle medial epicondyle. For a cord like structure. b. Infraglenoid tubercle Identify it c. Intertubercular groove 18. Draw a diagram to illustrate the branches of d. Head ,neck and tuberocity of the brachial artery in the arm radius 19. e. Olecranon and the coronoid process of the ulna Cubital fossa

5. Study the radiograph to identify the skeletal 1. Spot framework of this area a. Medial epicondyle 6. Reflect the remaining skin using the b. Lateral epicondyle dissection instructions given in page 20 from c. Olecronon fossa 7-16:figure 22B d. Medial and lateral supracondylar 7. Study the superficial veins in this region ridges 8. Draw a labelled diagram to illustrate the 2. In the living identify and observe the cubital superficial veins in the cubital region fossa 9. Continue with the dissection instructions in 3. On the front of the elbow identify the two page 32-34 up to cubital fossa muscular elevations, one on either side, 10. Spot separate above but converging below. a. Lateral and medial intermuscular 4. In the living On the front of the elbow septum identify the two muscular elevations and the b. Muscles in the anterior triangular depression between them when compartment the hand is extended. c. the attachment site of each muscle 5. In the medial elevation identify the most in the bony skeleton lateral muscle of the medial group. keep d. bicipital apponeurosis your fingers over this muscle, flex the elbow e. musculocutaneous nerve to 90 degrees , pronate it and try to push f. lateral cutaneous nerve of the against the resistance of the fingers on it . forearm Feel the depression; cubital fossa lateral to 11. Tabulate the action nerve supply and the it. Trace the muscle up to the up to medial spinal segments that innervate the muscles epicondyle. Identify this muscle. Mark its mentioned above attachments in the dry bones. 12. Using bones or an articulated specimen spot 6. Draw a labled digram to illustrate the the attachment sites of muscles of the arm boundaries of the cubital fossa 13. In the living demonstrate the bicep brachii 7. In the living Flex the elbow to 90 digress. muscle and feel the distal attachment/s Pronate the hand. Now feel the cubital fossa and supinate the forearm while keeping the fingers in the cubital fossa. Feel the cord like tendon. Identify it. 8. Drag your finger over the tendon to medial Flexor region of the forearm side to feel a cresentric edge. Identify the 1. Read the dissection overview: page 36 structure that forms this. 2. Study the bony landmarks of the region 9. Just above the cresentric edge feel the :page 37 arterial pulsations. Identify the artery. 3. On the humerus Spot the 10. In the living hang down the hand and apply a. Medial epicondyle a tourniquet just above the cubital fossa to b. Medial supracondylar ridge compress the superficial veins. Observe the c. Lateral epicondyle superficial veins and identify them. d. Lateral supracondylar ridge 11. Proceed with the dissection instructions in e. Capitulum page 34-35 up to posterior compartment f. Trochlea 12. Spot (at the cubital fossa) g. Olecranon fossa a. 4. On the radius Spot the b. Pronator teres a. Head c. Brachialis in the floor of the cubital b. Neck fossa c. Tuberocity d. Tendon of the brachii d. Anterior oblique line e. Bicipital apponeurosis e. Ulna notch f. Median nerve f. Styloid process g. Brachial artery g. Interosseous border Posterior compartment of the arm 5. On the ulna Spot the a. Olecranon 1. Spot the Radial groove of humerus b. Trochlear notch 2. In the living on the back of the arm, observe c. Radial notch the longitudinal muscular elevation d. Head emerging from under cover of Deltoid and e. Interoseous border gradually passing into the olecrenon . 6. Study the radiographs supplied Identify this structure. 7. Continue with the dissection instructions in 3. Proceed with the dissection instructions in page 37-40 up to the deep group of flexor page 34-36 muscles 4. Spot the attachment sites of triceps muscle 8. Spot the superficial group of flexor muscles in the bony skeleton proximally 5. Spot the 9. Tabulate the attachments, action/s, nerve a. Radial nerve supply and the spinal segments of superficial b. Deep artery of the arm group of flexor muscles c. Anconeus 10. Spot the attachment sites of the superficial 6. Tabulate the action , nerve supply and muscles in the bones/articulated specimen segmental supply of triceps and anconeus 11. Spot the 7. Draw a diagram to illustrate the course of a. bifurcation of the brachial artery radial nerve from the posterior cord through b. radial artery the arm to fore arm c. ulnar artery 8. Study the radiographs supplied d. median nerve at the cubital fossa 9. dissection review and at the wrist e. superficial branch of the radial nerve

f. deep and superficial parts of the the lateral wall of the cubital fossa. Trace it pronator teres proximally to the supracondylar ridge and g. common interosseous artery and distally to the radial styloid. Identify it. name its branches 18. Draw a labelled diagram to illustrate the 12. arterial anastomosis around the elbow 13. In the living identify the other muscles that 19. Continue with the dissection instructions in contribute to the formation of the medial page 40 –deep group pf flexor musles muscular elevation. Mark their attachments 20. dissection review in the dry bones. 21. Spot the deep group of muscles in the 14. In the living extend the elbow and feel the forearm mass lateral to the cubital fossa between the 22. Tabulate the attachments, action/s, nerve thumb and fingers. Trace it above to the supply and the spinal segments of deep lateral epicondyle and lateral supra condylar group of muscles in the forearm ridge. Understand that the lateral mass of 23. Spot the attachment sites of deep muscles in muscles arises at a higher level than that of bones/articulated specimen the medial. Identify the other muscles that 24. Study the cross sections of the forearm to contribute to the formation of the medial understand the compartments muscular elevation. Mark their attachments 25. Draw labeled diagrams to illustrate the in the dry bones. course of 15. In the living a. Radial nerve a. Observe the medial contour of the b. Median nerve medial border of the forearm. c. Ulna nerve Identify the muscle that forms it. d. Radial artery trace it down to the pisifom bone e. Ulnar artery b. Feel the tendon of the above In the fore arm muscle while flexing the adducted hand. Mark its attachments in the dry bones.

c. To the ulna side of this tendon feel the ulnar styloid and trace the ulna along the subcutaneous dorsal border up to elbow d. To the radial side of the tendon feel the arterial pulsations . Name the artery.

16. In the living flex the clenched fist and observe the front of the wrist. Identify the tendon that stands out as a sharp, tense cord in front of the middle of the wrist. Identify the cord like tendon that is lateral to abve tendon. Feel lateral to this tendon for the arterial pulsations. Name the artery. Observe

the elongated depression medial to the cord like tendon identified before. Identify the structures in it. 17. Flex the elbow against resistance with the forearm midway between pronation and supination. Feel the prominent elevation on